Etiology:Cirrhosis is a complication of many diseases that is characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis injure and kill the liver cells and the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The causes of cirrhosis include alcohol, fat, and certain medications. Also virus, toxic metals, and autoimmune liver disease are causes of cirrhosis. Carliani Rambo

Signs/Symptoms: Patients with cirrhosis may have few or no symptoms and sign of liver disease. Some of the signs include: Yellow skin do to accumulation of bilirubin in the blood, fatigue, weakness, lost of appetite, itching, and easy bruising do to decrease of the production of blood clotting. Carliani Rambo

Method of Diagnosis: One of the best methods of diagnosis is the biopsy of the liver. However it carries a small risk for serious complications, so it is done when only in patients were the type of liver disease or the presence of cirrhosis is unclear. Also cirrhosis may be diagnosed by the patient's history, physical examination, or routine testing. Carliani Rambo

Risk Factors:
*Modifiable: Alcohol, intravenous drug abuse, and fat.
*Non-Modifiable:Hepatitis B or C.

Prevention: Consume a balanced diet and one multivitamin daily. Avoid alcohol, and nonsteroidal anti-inflammatory drugs (NSAIDs)

Supplements Commonly Used: Antioxidants found in fruits, vegetables, and whole grains. Betaine to reduce homocysteine levels. Herbs like Bupleurum ( have antioxidant properties), and Licorice root ( reduce the riks of cirrhosis for people with hepatitis C). Carliani Rambo

Labs Appropriate to Disease:

The following findings are typical in cirrhosis:
Values in the Disease:

* Aminotransferases - AST and ALT are moderately elevated
* Alkaline phosphatase - usually slightly elevated.
* GGT – correlates with AP levels. Typically much higher in chronic liver disease from alcohol.
* Bilirubin - may elevate as cirrhosis progresses.
* Albumin levels fall as the synthetic function of the liver declines with worsening cirrhosis since albumin is exclusively synthesized in the liver
* Prothrombin time - increases since the liver synthesizes clotting factors.
* Globulins - increased due to shunting of bacterial antigens away from the liver to lymphoid tissue.
* Serum sodium - hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.
* Coagulation defects - since the liver produces most of the coagulation factors
Blanca Torres

Other laboratory studies performed in newly diagnosed cirrhosis may include:

* Serology for hepatitis viruses, autoantibodies (ANA, anti-smooth muscle, anti-mitochondria, anti-LKM)
* Ferritin and transferrin saturation (markers of iron overload), copper and ceruloplasmin (markers of copper overload)
* Immunoglobulin levels (IgG, IgM, IgA) - these are non-specific but may assist in distinguishing various causes
* Cholesterol and glucose
* Alpha 1-antitrypsin
Blanca Torres

Nutritional Significance:
**This disease may also alter the results of the following tests:

* Cholesterol test
* Complement
* Alpha-fetoprotein
* Renin
* Serum magnesium

The severity of cirrhosis is commonly classified with the Child-Pugh score. This score uses bilirubin, albumin, INR, presence and severity of ascites and encephalopathy to classify patients in class A, B or C; class A has a favourable prognosis, while class C is at high risk of death. Blanca Torres

General Dietary Prescription: High- quality dietary protein to repair muscle mass, lower the salt in the diet, and avoid raw shellfish.

Specific Foods to Include: Nuts, seeds, yogurt, fresh fruits and vegetables.

Specific Foods to Avoid: Salty foods and fat food.
Carliani Rambo

Reccomended Prescription Drug Therapy: Prednisone and azathioprine to decrease inflammation of the liver in autoimmune hepatitis. Also ursodeoxycholic acid it retards progression, but does not cure PBC. Diuretics such as, aldactone and furosemide are medications that promote the elimination of salt and water in the urine. Carliani Rambo

Potential Food and Drug Interactions:
Sensitivity to medication: Cirrhosis slows the liver's ability to filter medications from the blood. Because the liver does not remove drugs from the blood at the usual rate, they act longer than expected and build up in the body. This causes a person to be more sensitive to medications and their side-effects.
Black liquorice more than anything else that should be totally avoided with diuretics they will produce dangerously low potassium levels leading to numbing weakness, muscle pain, irregular heartbeat, paralysis and even cardiac arrest. Although there many foods and drugs that must be taken into consideration when taking diuretics there is an even higher number of seemingly benign herbs that must be eliminated; alder, buckthorn, buchu, cleavers, dandelion, digitalis, gravel root, horsetail, juniper and uva ursi which if taken can enhance the medicines power leading to cardiovascular side effects. Blanca Torres

General Nutrition Education Objectives or Goals: Avoid alcohol consumption, take a multivitamin that is easily soluble, eat several portions throughout the day, and avoid animal fat and animal protein. Carliani Rambo

Carliani Rambo & Blanca Torres

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